WAI GUAN – SJ5

Location

On the dorsal aspect of the forearm, on the line connecting SJ 4 and the tip of the elbow, 2 cun above the transverse crease of the wrist between the ulna and radius

  Biomechanisms overview

The main research on the actions of Waiguan is on its effects on the central nervous system, which areas of the brain it activates, benefitting post-stroke hemiplagia and cerebral palsy, how it protects neurones, and speeds up recover from surgery as well as its effects on the immune system.

 

Central nervous system regulation

Unilateral acupuncture at Zhongzhu (SJ3) and Waiguan (SJ5), highly-activated the cingulated gyrus, temporal gyrus, cerebellum, occipital gyrus, these changes may be important for acupuncture analgesia (1). 

Compared with sham acupuncture, acupuncture at Waiguan in stroke patients inhibited Brodmann area 5 on the healthy side. Results indicated that the altered specificity of sensation-associated cortex (Brodmann area 5) is possibly associated with a central mechanism of acupuncture at Waiguan for stroke patients (2).  

Another study showed needling SJ5 in the healthy upper limb resulted in specific directional brain action, as manifested by deactivation of cerebral areas related to motor (Broadmann 4 and 6), emotion (hypothalamus), and cognition (Broadmann 24, 32) in post stroke patients (3). 

Acupuncture at Waiguan exerts neuroprotective effects by regulating the expression of anti-apoptotic gene Bcl-2 (4).

Acupuncture at Waiguan, combined with Shousanli (LI10), Yanglingquan (GB34) and Zusanli (ST36), significantly ameliorates upper-lower limb motor function, limb sensory function, balance, and joint range of motion in post-stroke hemiplegia (5). 

Acupuncture at Waiguan and Shousanli also improves motor function and self-care abilities in children with cerebral palsy (6).  

Electroacupuncture at LI4 (Hegu), SJ5 (Waiguan), ST36 (Zusanli), BL63 (Jinmen), LR3 (Taichong), and GB40 (Qiuxu) significantly shortens ​​recovery from anesthesia, the autonomous respiration recovery time, tracheo-tube removal time, eye-opening time, voluntary motor recovery time, orientation force recovery time, and the operating-room departure time for patients underdoing Supratentorial Craniotomy. It also elevated serum enkephalin important for its painkilling (anti-nociception) effects (7).

Immune system modulation

Acupuncture at at Danzhong (REN17), Zhongwan (REN12), Qihai (REN6), Zusanli (ST36), Xuehai (SP10), Waiguan (SJ5), and Taichong (LV3) significantly increases the percentage and absolute counts of B cells and CD4+T cells, the absolute count of CD3+T cells in the treatment group were up-regulated in patients with non-small cell lung cancer, as well as improving fatigue and quality of life (8). 

Electroacupuncture at Waiguan and Hegu (LI4) can decrease the incidence and severity of etomidate-induced myoclonus and reduce pain scores post hysteroscopy (9). 

Musculoskeletal conditions

Acupuncture at SI8, alongside Quchi (LI11), Shousanli (LI10), Hegu (LI4), Tianjing (SJ10), and Waiguan (SJ5) ‘can produce excitation in motor nerves and muscles, and nerve stimulation increases the recruitment of motor units, thus improving the muscle explosive force.’ This was shown in increases in; the average max torque, average work, average power, average peak power, average max speed, and total work or, in sum, explosive force increases (10). Furthermore, the same points showed acupuncture increased muscle endurance, albeit in a very time limited way – 7 to 21 minutes before it waned – within their parameters (11). 

References

  1. Yan-Li, J. (2009). Study of acupuncture Zhongzhu(SJ3) and Waiguan(SJ5) by functional MRI(FMRI). Chinese Journal of Information on Traditional Chinese Medicine. https://pesquisa.bvsalud.org/portal/resource/pt/wpr-579606 
  2. Qi, J., Chen, J. Q., Huang, Y., Lai, X., Tang, C. Z., Yang, J., Chen, H., & Qu, S. S. (2014). Acupuncture at Waiguan (SJ5) and sham points influences activation of functional brain areas of ischemic stroke patients: a functional magnetic resonance imaging study. Neural Regeneration Research, 9(3), 293. https://doi.org/10.4103/1673-5374.128227
  3. Huang, Y., Xiao, H., Chen, J., et al. (2011) Needling at the Waiguan (SJ5) in healthy limbs deactivated functional brain areas in ischemic stroke patients: A functional magnetic resonance imaging study. Neural Regeneration Research 6(36):p 2829-2833. Available at: https://journals.lww.com/nrronline/Abstract/2011/06360/Needling_at_the_Waiguan__SJ5__in_healthy_limbs.5.aspx
  4. Dong, L., Lin, L. Y., Sutherland, K., & Cao, C. (2016). Manual acupuncture at the SJ5 (Waiguan) acupoint shows neuroprotective effects by regulating expression of the anti-apoptotic gene Bcl-2. Neural Regeneration Research, 11(2), 305. https://doi.org/10.4103/1673-5374.177740
  5. Huayuan, Yang, K., Tangyi, Liu, M., Yanhong, Wang, H., Sheng-Guo, Ying, Y., Chaoying, Zheng, Z., Le, Kuai, MingGao, Youjiang, & Min, M. (2008). Acupoint electrogymnastics therapy in stroke hemiplegia. 中国神经再生研究：英文版, 3(10), 1145–1151. http://www.cqvip.com/QK/88507X/200810/28924921.html
  6. Zhang, B., Zhu, Y., Jiang, C., Li, C., Li, Y., Bai, Y., & Wu, Y. (2018). Effects of Transcutaneous Electrical Acupoint Stimulation on Motor Functions and Self-Care Ability in Children with Cerebral Palsy. Journal of Alternative and Complementary Medicine, 24(1), 55–61. https://doi.org/10.1089/acm.2016.0111
  7. Yang, C., An, L., Han, R., Lin, S., Kang, X., & Wang, B. (2012). Effects of Combining Electroacupuncture with General Anesthesia Induced by Sevoflurane in Patients Undergoing Supratentorial Craniotomy and Improvements in Their Clinical Recovery Profile & Blood Enkephalin. Acupuncture & Electro-therapeutics Research, 37(2), 125–138. https://doi.org/10.3727/036012912×13831831256249
  8. Li, W., Liu, Y., Pan, P., Ye, S., Xia, Y., Liu, A., & Yu, J. (2020). [Effects of “Tiaoyi Sanjiao” acupuncture and moxibustion on cancer-induced fatigue and immune function in patients with advanced non-small cell lung cancer]. PubMed, 45(12), 1000–1005. https://europepmc.org/article/med/33415860 
  9. Lv, Y., He, H., Xie, J., Jin, W., Shou, C., Pan, Y., Wang, L., Mo, Y., Dai, Q., Geng, W., & Wang, J. (2018). Effects of transcutaneous acupoint electrical stimulation combined with low-dose sufentanil pretreatment on the incidence and severity of etomidate-induced myoclonus. Medicine, 97(23), e10969. https://doi.org/10.1097/md.0000000000010969
  10. Zhou, S., Wang, I., Chen, Y., Hu, R., Su, Y., Shen, J., & Wang, J. (2021). Effects of Traditional Chinese Acupuncture Compared with Sham Acupuncture on the Explosive Force Production by the Forearm Muscles in Female: A Randomized Controlled Trial. Evidence-based Complementary and Alternative Medicine, 2021, 1–9. https://doi.org/10.1155/2021/1992753
  11. Su, Y., Yao, S., Zhou, Z., Wu, C., Wang, I., & Lai, C. (2022). Effect of Acupuncture on Time-Dependent of Muscle Endurance in Female elbow Joint: a randomized controlled trial. Evidence-based Complementary and Alternative Medicine, 2022, 1–10. https://doi.org/10.1155/2022/8052256